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The nursing home I'm considering sending my mom says there are some supplements they can't give, even with the doctor's prescription. Is this correct? How do I determine if they are just wanting simplicity or under the assumption they can't give the supplements when perhaps they can. What regulatory body would be the decider on this? She has been on supplements while I've been caring for her in my home. The nursing home has agreed to give her vitamin D and melatonin but are balking at some of the other supplements I've been giving her. Where can I find the definitive answer on if they are allowed by law or regulation to administer supplements? I was told that they can't give anything that isn't FDA approved, but I didn't think supplements required FDA approval. Yet they said they could give vitamin D for example. In addition, they were telling me if their pharmacy doesn't carry it, they can't give it. One of Mom's medications is specially compounded and not all pharmacies carry it. Can they refuse to administer a doctor-prescribed medication just because their pharmacy doesn't carry it? I'm not even sure who regulates this from the nursing home's perspective. FDA? HHS? Medicare? Though I will certainly pay for the supplements out of my own pocket, they said it is not a payment issue. Any help or direction would be appreciated.

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If they are in a NH it is considered a skilled nursing facility and as such all aspects of care including medications has to be done by physician's orders. Usually this comes from / comes through the medical director of the NH with the DON (DIrector of Nursing) who places orders and staffing based on what the MD prescribes. SOmetimes the elders prior physician is involved but usually once they go into a NH, their old MD turns over care to the medical director of the NH.

All this is in the admissions agreement. You do not demand that they do xyz for your family member - all that does is cause problems. Once they are in a NH, there is a care plan meeting required to be done on a regular basis by CMS. For my mom in both of her NH, the first one was done within the first 30 days and then every 90 days thereafter. A letter was mailed as to the upcoming CPM and a # to call to set the exact time for the meeting. SOme I went to in person & some were done via CC. The CPM is where you can voice your concerns and request specific things be looked at -everybody front the various departments (dietary, activities, social work, nursing) will be there and will have a short report on your elders status for their department. CPM's are very insightful if you manage it right, and is very much a way to ensure what you want do is put into action. If something in serious, then the DON comes to the CPM otherwise the DON will send the RN who is the floor director or section manager for the unit your family member is in.

There is no reason why you cannot be totally prepared for the CPM with a list of items you want addressed and state why and what you suggest as a solution for them with documentation as to why (like a letter from their old MD that the specific supplements were given under their orders). When the CPM is done (takes under 30 minutes), you will be asked to sign off on having the meeting - at this point in time if you don';t agree then you add in what you want or you put clearly that the report you did and brought to the meeting was delivered and to be added to your elders chart. At my mom's first NH, the last CPM meeting I brought in a pretty scathing report with photos and wrote clearly on the CPM as per attached report and I would not leave the meeting till I got a copy of the CPM that had all the signatures of staff at the meeting. The DON was not happy, but this is totally within my rights as DPOA MPOA - I already had mom set up to move to a new NH later that month, so no blowback.I also filed a Stark complaint on this NH. If you have issues with a facility, you have to clearly document date & time on all this and then do the follow up in letters to CMS and your DHHS or whomever administers Medicaid for your state. All NH are state regulated and that body should also get your letter of concerns. Everything must be in writing with your authority indicated (DPOA, Guardian) and I would send all certified mail with return registered card (the green card @ USPO). Venting on this site is terrific but you have to do the follow up in writing and with a chain of verification to get things done.
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Hahaha whoever is thinking about putting their relatives in a nursing home I think you should start saving for those funeral and cemetery expenses because they are going to give you a big surprise. Those animals working in nursing homes kill elderly patients. They lie in their records to protect themselves. This is what they do best, not I do not mean taking care of patients who need their attention. I mean this is what they do best in killing them and hiding the truth. They killed a relative of mine and I almost lost a second one. The government protects them and if you think your relative will get the best care there hahahaha you will have to learn the real truth very soon.
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Get a Nutritionist on your side because they know more about healing the body than the Medical Establishment suppressing your Moms recovery.
To clarify and expand on some of the answers here in regards to supplements being a waste of time, On the contrary, other forms of alternative methods for making the elderly healthier should always be encouraged. The USA is a bit behind compared to the rest of the world when it comes to healing the body instead of just removing or alleviating symptoms. Doctors do not get their degrees to cure or reverse illness, they go to get Medical Degrees and learn specific remedies that ONLY stop symptoms, NOT cure or reverse because the curriculum and the courses are not designed to do that. They are designed only to treat body ailments and how to block body systems that cause the pain temporarily. The Medical institutions do not look at the CAUSE of an illness.
Supplements in ADDITION to implementing other systems of healing and alternative strategies, can definitely reverse what looks like Alzheimer’s or Dementia and even alleviate Parkinson’s symptoms. Medically trained doctors will attest to this when their own patience begin to go downhill and then begin to improve after using alternative strategies. Getting more hydration can stop the brain from shrinking and better sleep alone WITHOUT NIGH-TIME WAKING, can reduce dementia like symptoms by 75%. Eliminating UTI without antibiotics and by regularly giving cranberry WITHOUT SUGAR but with RAW honey, and giving probiotics DAILY and a list of other foods like certain fatty acids like coconut oil and fish oil. An example of how delicate the brain is would be the movie "Lorenzo's Oil" with Susan Sarandon. Lorenzo, their sons mind was deteriorating and the parents learned that a fatty acid in seeds and another oil could benefit. Sure enough it did. http://en.wikipedia.org/wiki/Lorenzo%27s_Oil
Food is what fuels the body and makes it work properly. FDA rules disqualify many methods of research which prevents obvious solutions to be considered a valid remedy. We know that water, and a small snack can stop a headache, but we don’t see this as a remedy promoted by anyone on TV. We only see an ad for Tylenol. The USA Is too young of a country to have enough experience at healing disease. We need to learn from cultures that have a more reliable history with healing the body and a track record of what has worked and is still working because these are known healing systems that have been passed down. They can not be proven in double blind studies because no one looking to make a profit will have anything to sell so the studies will not have any investors. Remember, all doctors of modern day have learned from regular people. All that was done is that institutions have created a system of STOPPING or REDUCING symptoms by using ONLY drug and have created course work for students on HOW to administer these drugs. In those institutions, it is NOT profitable to teach a student any curriculum that creates a practice that cures the physician’s patients otherwise there would be no patients coming back into the doctor’s office and no drugs to prescribe. There is no secret here. GO anywhere else in the world in more rural areas and there is no doctor yet the people know how to cure themselves, how to stitch up wounds and also hot to perform cataract surgery. Cataract surgery was learned in India.. same as so many other healing methods that are not taught in the
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Nursing homes do not give anything without a doctor's orders. My aunt was in for rehab for 22 days. They gave her a vitamin and Tylenol, but asked me to bring in her bottle of cranberry pills, which I gave her to prevent UTI's. BTW, they didn't, and shortly after discharge, she developed a bleeding problem. I discontinued most of the Tylenol and the cranberry pills. No more bleeding. But a lot of supplements interact with regular meds. I once heard a natural physician say that if they are strong enough to do good, then they are strong enough to have side effects and interact. My feeling is that when is person is ready for NH care, supplements do not do any good and may do more harm then good. The only type of supplement that may be good is a Boost type supplement if one is not eating properly. At my aunt's NH, a lot of the patients received their Boost shake at mealtime.I would think it would be hard to hide a supply in the room, so you'd have to carry a can in your purse when visiting.
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Christine if you mother is subject to abuse please notify your States health dept so they can investigate. Photograph anything you can.
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Reading through these posts and living through nursing home hell myself, it's obvious to me that its all a fight. I regret that my mother's condition precludes her living with me. Now I have to put up with--or fight--all kinds of abuse, but either way, I lose.
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The nursing staff must give the supplement if the MD prescribes it. They are not permitted to "ignore" a physician order just because it does not "suit them."

However, as pointed out above, the supplements must be available in single-dose form - such as blister pack. They cannot be taken out of an open bottle. It's a health and safety issue. (BTW - I am a registered nurse.)
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Nursing homes and other care homes, have regulations that govern what is given to patients, how they are given, etc..
They are not just safeguarding your elder, they are safeguarding other inmates--because many of those roam about, and pilfer things from other rooms, for instance. So nothing edible or meds can be left in the rooms.

If it's a supplement that's a pill/capsule, etc., Doc should be able to order it, and it would be dosed off the med.cart by the nurses, with regular med rounds.
IF the facility is telling you they aren't allowed, even if the Doc orders it?!
QUESTION THAT.
Look into how the rules actually are written--you may have to dig deep, and or, contact multiple agencies governing this, at the State level---because as others mentioned:
Corporations often lie, or, word things in ways to cover up what the situation really is....like: some store employees tell customers an item is not available anymore--can't be got....what they are really covering is: the chain store no longer carries that item, so wouldn't you be happy buying this other thing they do have?...
If it's a food supplement, such as "Boost" or another meal replacement shake or something, it might be that you could give her that when you are visiting, but not leave it there for the facility to give her.....
It's common for facilities--particularly chain operations, to Contract with corporations to provide certain Brands of things--like Ensure, for instance [just using that as an example only]. In those kinds of contracts, clauses can forbid the facility personnel from giving patients competing brands of similar products--so they just tell people they "can't give those, even if those are prescribed".

BUT...having worked in nursing homes, I can tell you there are Docs who DO prescribe supplements [even if they don't do it well, they are trying to help], like vitamins, minerals, even probiotics, CoQ10, etc., which ARE kept on the med cart, get dosed as ordered, at med rounds, or as-needed [PRN]....those have also included some meal replacement shakes in single-serving cartons or cans.
As long as stuff is not at the bedside/in rooms for anyone else to pilfer, as long as it is dosed properly as Doc orders it, by staff, from the med cart or med room, it should be do-able.
Unless that facility is under contract by some corporation that limits what they can do.
Can't imagine any State forbidding supplements. Just facilities or their personnel if they don't want to deal with extra stuff. I've met some of those, too.
As well as met some staff who pilfer the "extras".
One facility told me they discouraged supplements, because they knew those were expensive, and they didn't want families to get their hopes up unrealistically. They felt they were doing the families a good service, by limiting the dosing of nutritional supplements [costly], and preventing families building up hopes that those could cure or fix their elders conditions.
So many people are mal-nourished!
IF properly diagnosed for nutrients, they might get some serious relief of symptoms, just by getting proper nutrition. When there's, obesity, diseases....underneath that, is long-term poor nutrition, slowly compromising the body's ability to function, until it becomes a disease-state. We know so much most Docs don't use or deny, and need to know so much more!
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There is an OMBUDSMAN for long term care - check with them about the rules in your state. Get PCP involved...who will the PCP be in the NH? That may make a difference.
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Just making sure u know, you won't be able to use your parent's prescription plan. They have their own parmacies and parent will pay out of pocket. Don't know how it works between PC and the doctor associated with the facility.
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Here in NY, any adult home, ALF or NH must have written MD orders for any meds, including over-the-counter items like vitamins and topical creams and even cough medicines. No one can demand the staff give anything or hold anything back. Doctor's orders only, that's the law.
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To continue as it posted by itself. Suppliments vary in their quality and may even not contain any of the ingredient they claim to have. if you actually call the company you will recieve a very evasive answer such as "It is a therapeutic amount" so you may well be buying sugar pills.
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The nurses who administer meds in a nursing home can only give what the Dr has ordered. Those medications are dispensed sperately for each patient and placed in the drug cart by the pharmacy.
Most nursing homes have their own Dr on staff who oversees all patient treatment unless they need to go outside for specialized treatment for such things as dialysis.
I do not know how dental treatment is provided but in my opinion a filling would be more palliative than an extraction.
Nursing homes vary in quality as many have observed so once again due diligence will get the best care for your loved ones. Visit at many different times of the day so you can see how your loved one is truly treated.
the whole subject of suppliments is a very thorny
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No, it is not a payment issue. It has to do with the FDA NOT being able to regulate supplements which are mostly expensive pee, and the nursing home you are considering does not have to do anything they do not want to do based on their guidelines. It sounds to me like they want to keep all the money in house with meds only in their pharmacy. It is their right to do that. Try contacting other nursing homes to fit your needs and don't be surprised if the others want only FDA-approved drugs. Their are covering their as------ just in case of a lawsuit. Take them to her if you can if you want her to have them so much. Discuss the importance of taking the doctor prescribed meds, and if they will not make a difference (Nothing will help a person with dementia), then choose the nursing home based on your desires.
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Judyjourneys:

You seem to be "my type of girl"

Sonny
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I think my father died prematurely for the same reasons.
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I am getting "nauseated" from hearing from so many caregivers that a personal caregiver such as a son, daughter or spouse should ask the doctor, nurse or an aid if a supplement is ok after a cognitent patient has been taking a nourishing and non medicinal supplement for some time with beneficial results and then told...no by a "professional" that he/she can't have one. That is ridiculous.

I believe that it would be best if at all possible, is to take your loved one home and have the nurse and therapist come to your home rather than have the person locked up in an institution. I believe my wife died unnecessarily because of the neglect and all of the pills that were given to her under "doctors" orders. Her personal doctor was not allowed to interfere with the "institutions" doctor!
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In my experience with two nursing homes for my father (Pennsylvania and Texas), every "higher-up" I dealt with was a disappointment, including social workers, administrators, and ombudsman. Please read the book, Before the Door Closes by Judith Hall Simon and see for yourself the tangled web of travesty the elderly--and their caregivers--are caught in.
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I am not suggesting the patient have the bottle of pills in their room (unless in one of those locked cabnets). What I am saying is, if the resident already took a supplement, like Move Free, successfully at home without any issues, then the ALF which is receiving a fee to dispense medication,.should not be refusing to give something like Move Free, simply because their preferred (read: financially connected) pharmacy doesn't have it in a blister-pak. That's really ridiculous. Residents should get their medicine AND supplements that both doctor and Patient prescribed. It's all about human rights --they have a right to refuse medication and they have a right TO take something. As long as they ate competent tthey are wwithin their rights. If they are no longer competent, their Medical POA takes over,.doing what the person would have wanted. The Facility has no right to overrule the resident, or the resident's Medical POA..
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mallory, the other issue is drug interaction with normal food or over the counter items that the patient or family may be unaware of. If the patient is allergic to shellfish, then Move Free with chondriotin could be a problem. If the patient is on an immuno-suppressant, then echinacea will be out. If the patient is on MAOI inhibitors, there can be a significant interaction with items like cough medicine and Sudaphed.

When people lived in their own homes, they assumed full responsibility for what meds and supplements they took. Once the NH assumes legal responsibility, they are going to expect full knowledge of everything that patient ingests.
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The reason why facilities don't allow patients have Tylenol and other supplements laying around is because they could take it ten times a day, or another patient could decide to help themselves too. It really is understandable!
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It's so unfortunate that everything has to have a doctor's order. What did people do in their own homes, before they moved to the facility? Unless it is harmful then they should be able to continue, at the facility. Smoking cigarettes (or other "herbs" lol) would be about the only thing a facility could disagree with. If you want your mom to take "Move Free" for Joint pain instead of Tylenol then the facility should carry out that PATIENT REQUEST. Why are "doctor's orders" automatically placed above "Patient (or Medical POA) Request"?
Whoever is paying the BILL should be the one who says what supplements are given.
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Everything has to have a doctors order for it. You might have to discuss this problem with her doctor, and write down what's ok for her to take----she still has to have an order for it. Some supplements might not mix well with her medications.
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Please do not write my reply in stone, for I stand to be corrected of course, but if the supplements are or can be considered just food type stuff, I think we as family members are allowed to take Example: fruit, vegetables, other goodies,etc. into the room and if individual is able to eat them without injury to their diet and health, they are able to consume those items as food. However I personally had an experience when in a care center , due to cracking my arm and waiting for it to heal enough to go home and care for myself. Vitamins. They did not recommend my taking vitamins in their establishment. So, I said, I am able to walk, do I just take them outside to my car and take them in your parking lot, or must I drive the car off your parking lot to public road, then take the vitamins? Finally they consented to let me have them in a special containment box, so I got a tool box with latches on it, and hid it under my things, so that roaming patients from other areas (something they like to bring up to prevent you from having things like that in your room) could not get a hold of them. Rules and regulations of nursing homes nearly wore me out over the years. My mother was in one for nearly 7 years, my husband off and on for month here and there, myself when breaking leg and arm at same time a few years ago, then the cracked arm, when my husband was at that time presently in care center again. Believe it or not we were located in same room while my arm was healing. So it goes. There may be a way to work around things, if you personally were able to dispense the vitamins to your loved one. But that causes limitations for your schedule as we all know. Gas, time, travel and whatever. Rules and regulations should not be so difficult for people to survive according to their personal desires, but it seems many are just up against it. Hoping something good will work out for you. joylee
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A LTC facility cannot refuse to give ANYTHING if there is a doctor's order for it. They're yanking your chain. They don't have the unilateral and/or independent decision-making powers to say yes or no to what a doctor orders. But it would be helpful if you said what supplements you want your mother to have & what compounded medication they won't get for her.

Usually, the state Department of Health is the regulatory body for LTC facilities. There is a federal law that governs state laws for LTC facilities, which is CFR 483, "Requirements for states and long term care facilities". It outlines the requirements that each state must enforce. Section 483.60 covers Pharmacy Services.

I worked in a LTC facility many years ago as a nursing administrator, and from what I remember about billing & medications & things, insurance/Medicaid pays for prescription medications & the LTC pays for anything else that is prescribed that is not covered by insurance/Medicaid. I don't know if that still applies. If it does, what they're telling you is just a cost-saving measure for them because they don't want to spend the money. Sometimes certain meds are not on their formulary, but they will find an appropriate substitute & request the physician's approval to substitute the medication for the one that was ordered. It's usually the cheapest option available. I don't know what the deal is with "supplements", though. I don't know what "supplements" you're talking about.

Why were you giving your mother the supplements? Did she have verified low levels of vitamins and/or minerals that she required them? Or were you giving them because you wanted to for no special reason? What result do you expect from the supplements? I'm not sure that at your mother's age & with Alzheimer's/dementia, all the supplements are necessary. The Alzheimer's/dementia likely won't improve, so why have her take all these extra supplements? Concentrate on having her live her life with the highest quality possible.

If one of the meds your mother is on is compounded at a specialty pharmacy & her doctor determines that it is necessary for her to take it, it is the responsibility of the LTC facility to get it. LTC facilities are usually contracted with a local pharmacy that services LTC facilities & other places, & they want to operate as cheaply as possible. If the pharmacy that the LTC facility your mother is in won't/can't compound the medication, then give the LTC facility the name of the pharmacy that compounds the medication & have the specialty pharmacy send it to the facility once a month or on a regular schedule. Or, you can fill/re-fill the prescription, pick it up & bring it to the LTC facility.

It angers me that LTC facilities spend so much money marketing themselves as these utopian places, with wonderful care & offering everything a person could ever want or need, and then when they get their hooks into you, it's all about doing it as cheaply as possible, despite how much they are getting from each person every month. The majority of LTC facilities are for-profit enterprises, and the owners/administrators take home a very tidy salary every year.
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For every state there is an oversite agency that surveys and licenses facilities, in Maryland it is office of health care quality, in west Virginia it is department of health and human resources. Look for the oversite agency for your state, they should be able to give you an answer. The facility should have the number posted someplace visible in the hall, you can also contact the long term care ombudsman, who should be able to assist. Good luck.
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Well, Christine, I did write a book about the nursing home tragedy to make people aware of what goes on within those walls. Before-Door-Closes-Daughters-Alcoholic
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My mother is in a nursing home. She has been there for almost 6 months. It's very pleasant for a dementia unit. My best friend's mother is in a nursing home and has been for 8 years. What we have learned is that nursing home staff loves to throw their weight around. They lie. They love this "ultimate authority" power trip and to put it mildly, you may have a difficult time reasoning with them or making any progress changing their mind, even when you are 100% right and within your rights. You need to get an outside person involved. NH is a closed circuit. I would call the ombudsperson and have them schedule a care meeting to discuss this. That way the NH will know that they're being watched. Sometimes an outside person is the only way. Sad. When my mother entered the NH, they stopped her aricept and nameda without saying a word to me. When I told them that as her health care proxy I did not consent to stopping treatment, they closed ranks and everyone, even the social worker parroted the same line "those meds don't help." And they were FDA approved and had recently been shown to be benefcial to patients, through the late stage of Alzeimer's. I've had other people tell me the meds "stop working" or "don't help," but that's simply not supported by the science. The medication is, however, specialized, so I concede that it may only help people who truly have Alzeimer's, as opposed to other dementias. But I digress, the point is, I was within my legal right and they still violated it. I had to get a lawyer and threaten to sue. After I did that, they gave the meds back so fast it literally made my head swim! I was so stunned by the suddeness of it that I was unable to focus at work for the rest of the day. Nevermind the fact that a patient needs to be stepped up to my mother's dose. Another lesson I've learned is that there's this prevaling attitute that these people are on their way out anyway, so really great medical care is out of the question. Pretty disgustig, huh? Yesterday I took my mother to the NH dentist. He told me the only thing they do is cleanings, extractions and dentures. "Palliative care," he called it. Who concented to that? there's so much you don't know until you're actually in a nursing home. I should write a book. In short, the caregiving journey will break you down. The nursing home experience destroys you by beating you down and tiring you out until you don't have the strength to fight anymore. In my opinion, you won't get anywhere with these people until you get someone more powerful than them involved. Then you'll be surprised at how they are suddenly "able" to do something they were previously "unable" to do. Hypocrites! My wish is that for all the anguish they cause people's families, they get exactly, precisely what they deserve!
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Well... the assisted living my mom lived in would give everything the doctor ordered, however the AL had a triple tier pay scale for medicines given, the more medicines my mom took, the more we paid. Money talks! We had the doctor take my mom off everything that wasn't paramount to her health. We paid roughly $12 instead of $25 a day to administer medicines after the adjustments were made under the care of a new doctor. How important is that supplement? Is it worth possibly $10 extra a day? Careful what you ask for... hope this helps!!!
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Get support from her GP. Then they will not be able to argue with you.
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